Provider Demographics
NPI:1558371591
Name:EDELSTEIN, ARI (MD)
Entity Type:Individual
Prefix:DR
First Name:ARI
Middle Name:
Last Name:EDELSTEIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:12510 QUEENS BLVD
Mailing Address - Street 2:SUITE 322
Mailing Address - City:KEW GARDENS
Mailing Address - State:NY
Mailing Address - Zip Code:11415-1519
Mailing Address - Country:US
Mailing Address - Phone:718-263-5252
Mailing Address - Fax:718-544-5938
Practice Address - Street 1:12510 QUEENS BLVD
Practice Address - Street 2:SUITE 322
Practice Address - City:KEW GARDENS
Practice Address - State:NY
Practice Address - Zip Code:11415-1519
Practice Address - Country:US
Practice Address - Phone:718-263-5252
Practice Address - Fax:718-544-5938
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY125875207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00306249Medicaid
NY00306249Medicaid
B88057Medicare UPIN